The Certified Orthotists at the Centre for Orthotics and Medical Devices

7.00000000000000

68.0000000000000

2693.00000000000

Health (A-Z) - Procedure

Health A-Z

<p>Learn how to wear and take care of your Milwaukee (CTLSO) orthosis.</p>

<h2>What is a Milwaukee orthosis?</h2><p>A Milwaukee orthosis is a body brace worn to halt the progression of scoliosis and kyphosis. It is also known as a cervical thoracic lumbo sacral orthosis (CTLSO). It is worn over an undershirt to protect the skin.<br></p>
<figure>
<span class="asset-image-title">Milwaukee brace</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/Milwaukee_brace_EQUIP_ILL_EN.jpg" alt="Illustration of Milwaukee body brace" />
<figcaption class="asset-image-caption">The Milwaukee brace is custom fit to each patient. Often the patient has a choice of colours and patterns for the surface of the brace.</figcaption> </figure>
<br>
<br>
<br>

<h2>Key points</h2>
<ul>
<li>The Milwaukee orthosis should be worn for 22 to 23 hours per day by the end of three weeks.</li>
<li>This guide offers a suggested schedule to build up to the 22 to 23 hours slowly. You can make your own schedule if you prefer. </li>
<li>If you are having problems with your orthosis or your skin and the problems do not go away, make an earlier clinic appointment. </li>
<li>If you have any questions or problems, contact your orthotist. </li>
</ul>

<h2>Goal and requirements</h2>
<ul>
<li>Goal: To wear the Milwaukee Orthosis for 22 to 23 hours per day by the end of three weeks. </li>
</ul>
<p>This means that you need to:</p>
<ul>
<li>put on your orthosis properly </li>
<li>start wearing your orthosis gradually </li>
<li>look after your skin </li>
<li>clean your orthosis every day </li>
</ul>
<p>For general information about wearing an orthosis for scoliosis, including instructions for making cotton undershirts, please see <a href="/Article?contentid=974&language=English">Scoliosis: Treatment with a spinal orthosis (spinal brace).</a></p>

<h2>Putting the orthosis on</h2>
<ol>
<li>To put the orthosis on, spread the orthosis at the bottom of the back opening. Insert your arms through the orthosis on either side of the front upright. Slide the opening over one hip. Reach around the front and pull the rest of the orthosis around you. Make sure your neck is inside the neck ring that attaches the front upright to the back uprights.</li>
<li>Make sure all the straps and correction pads are outside the plastic girdle.</li>
<li>Make sure the orthosis is facing straight ahead and not twisted. The opening of the orthosis should be in the middle of your back. The opening of the orthosis at the back should be centered on the crease between the buttocks. The waist roll of the orthosis (the indentations inside) should sit at your waist, just above the hip bones.</li>
<li>Initially, it may be easier to tighten the orthosis while lying down. Your spine will be straighter. You will also have more room to tighten the orthosis properly. Once your spine becomes accustomed to the orthosis, you may be able to tighten it while standing up.</li>
<li>Thread the closure strap through the buckle on the lower part of the orthosis at the back and tighten to the marked hole. Do up the closure nut behind your neck at the top of the orthosis. As you do up the orthosis, you should be checking the positioning to ensure that the waist rolls are properly positioned. </li>
<li>Pull the extra cloth of the undershirt down around the bottom and top of the orthosis so that it is smooth.</li>
<li>Make sure there are no wrinkles in the undershirt. Wrinkles can cause sores on your skin.</li>
<li>The straps of the corrective pads should then be threaded under the uprights and done up on the appropriate buckles to the correct tightness (marks). You do not need to undo both front and back corrective pad straps when putting on or taking off the orthosis. Either front or back ends can be left done up and the opposite ends can be undone. </li>
<li>Always do the orthosis up in the marked holes. Never loosen it. If you wear your orthosis loosely, you will have skin problems and discomfort. A loose orthosis will shift around each time you move and irritate your skin and prominent bones (ribs and hip bones). If you experience regular stomach bloating, you may slightly loosen the orthosis (no more than one hole) on each strap for a short time. </li>
</ol>

<h2>At SickKids</h2>
<p>If you are an Ontario citizen, 75% of your spinal orthosis is paid for by the Assistive Devices Program (ADP). The remaining 25% is the responsibility of the family. Most private insurance companies may cover the cost of the client portion of the spinal orthosis. If you need help to pay for the orthosis, visit our reception desk for a listing of charitable organizations that may assist you. Please visit or contact The Centre for Orthotics for further information on pricing.</p>
<p>All proceeds from orthotic treatment at The Centre for Orthotics go to support patient care and research at SickKids. For more information, please see <a href="http://www.centrefororthotics.ca/">www.centrefororthotics.ca. </a></p>

The Certified Orthotists at the Centre for Orthotics and Medical Devices

7.00000000000000

68.0000000000000

2693.00000000000

Health (A-Z) - Procedure

Health A-Z

<p>Learn how to wear and take care of your Milwaukee (CTLSO) orthosis.</p>

<h2>What is a Milwaukee orthosis?</h2><p>A Milwaukee orthosis is a body brace worn to halt the progression of scoliosis and kyphosis. It is also known as a cervical thoracic lumbo sacral orthosis (CTLSO). It is worn over an undershirt to protect the skin.<br></p>
<figure>
<span class="asset-image-title">Milwaukee brace</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/Milwaukee_brace_EQUIP_ILL_EN.jpg" alt="Illustration of Milwaukee body brace" />
<figcaption class="asset-image-caption">The Milwaukee brace is custom fit to each patient. Often the patient has a choice of colours and patterns for the surface of the brace.</figcaption> </figure>
<br>
<br>
<br>

<h2>Key points</h2>
<ul>
<li>The Milwaukee orthosis should be worn for 22 to 23 hours per day by the end of three weeks.</li>
<li>This guide offers a suggested schedule to build up to the 22 to 23 hours slowly. You can make your own schedule if you prefer. </li>
<li>If you are having problems with your orthosis or your skin and the problems do not go away, make an earlier clinic appointment. </li>
<li>If you have any questions or problems, contact your orthotist. </li>
</ul>

<h2>Skin care</h2>
<p>It is very important to prevent skin breakdown (sore, red, raw skin). The skin under the orthosis needs to be toughened up, especially where the orthosis presses the hardest. </p>
<p>To protect the skin:</p>
<ul>
<li>Take a bath or shower every day. </li>
<li>Always wear a close-fitting, 100% cotton undershirt (tubular knit) without side seams against your skin. You can also use a T-shirt worn inside out so that the side seems are not against your skin. </li>
<li>Wear the orthosis with the straps at the marked spots. If you wear the orthosis loosely, it will move around and cause more skin problems. </li>
<li>Put on a clean, fresh undershirt at least once per day. In warm weather, it is advisable to change it two to four times per day, depending on how heavily you sweat. The drier you keep the undershirt, the more comfortable you will be. </li>
</ul>
<p>To toughen your skin:</p>
<ul>
<li>Do not use creams, lotions or powder under the orthosis. They soften the skin. </li>
</ul>
<p>To monitor your skin:</p>
<ul>
<li>Each time you remove the orthosis, check your skin right away for redness. If the redness lasts longer than half an hour, keep a close watch on these areas for bruising, purple discoloration, open sores or blisters. At the first sign of these symptoms, call your orthotist right away. Do not wait until your skin is raw or bleeding. </li>
<li>If the skin breaks down and becomes sore, red or raw, do not wear the orthosis until the skin heals. This will take one day or more. If this happens, call your orthotist right away. The problem may be solved over the phone. Do not use creams, powder or lotions. If irritation persists, call your orthopaedic surgeon or family doctor. </li>
<li>Sometimes the skin over the waist and hip gets darker. When the orthosis treatment is over, your skin will return to normal. </li>
<li>Continue your skin care regimen even after you are comfortable in the orthosis. </li>
<li>Make an earlier clinic appointment if your orthosis or skin problems continue. </li>
</ul>
<h2>Cleaning the orthosis</h2>
<p>The inner soft plastic foam must be cleaned every day. Use a cloth with an antibacterial hand sanitizer to clean the lining, then wipe the lining thoroughly with a damp cloth. Make sure all the sanitizer is wiped off the inside, as it could cause skin irritation. Clean the hard plastic outer shell with a damp cloth as needed. </p>
<p>A terry towel can help dry the orthosis. The orthosis will dry by itself in 20 to 30 minutes. If the orthosis is needed soon, a blow dryer set on cool can be used to dry it in five to 10 minutes. </p>
<p>Never put the orthosis in water or put it under the tap. Make sure the metal and leather parts do not get wet.</p>
<p>Do not leave the orthosis in very hot sun, in a hot car during the summer, or by a warm radiator. The plastic may soften and lose its shape. </p>
<h2>Clothing</h2>
<p>Loose-fitting clothes will not reveal the outline of your orthosis. Pants usually will be at least one size larger. Pants with elastic waistbands or drawstrings may fit more easily. </p>
<h2>Physiotherapy</h2>
<p>If your physician recommends it, a physiotherapist will give you exercises to do.</p>
<h2>Physical activity</h2>
<p>Orthosis wear tends to produce lazy muscles, especially in the stomach and lower back area, so it is extremely important to be as physically active as possible. You should participate in as many sports as you can and do the exercise prescribed by your physiotherapist daily. </p>
<p>Some sports such as baseball and bicycling may be done with the orthosis on. Other activities that need a lot of flexibility, like ballet, trampoline and gymnastics, may be more difficult to do with the orthosis. </p>
<p>Activities that require you to correct your balance quickly or need increased flexibility or increased air intake must be done with the orthosis off. These include: </p>
<ul>
<li>skating </li>
<li>snowboarding </li>
<li>downhill skiing </li>
<li>horseback riding </li>
</ul>
<p>When the orthosis is removed for sports, it is considered hours out of the orthosis. If you spend more than two hours out of the orthosis, simply continue with the schedule as closely as possible.</p>
<p>If you swim in salt water, wash the orthosis well with fresh water, then towel-dry it. Generally, you may swim without your orthosis since the water will support your back. Check with your doctor for specific instructions about swimming and other activities. </p>

<h2>Goal and requirements</h2>
<ul>
<li>Goal: To wear the Milwaukee Orthosis for 22 to 23 hours per day by the end of three weeks. </li>
</ul>
<p>This means that you need to:</p>
<ul>
<li>put on your orthosis properly </li>
<li>start wearing your orthosis gradually </li>
<li>look after your skin </li>
<li>clean your orthosis every day </li>
</ul>
<p>For general information about wearing an orthosis for scoliosis, including instructions for making cotton undershirts, please see <a href="/Article?contentid=974&language=English">Scoliosis: Treatment with a spinal orthosis (spinal brace).</a></p>

<h2>Putting the orthosis on</h2>
<ol>
<li>To put the orthosis on, spread the orthosis at the bottom of the back opening. Insert your arms through the orthosis on either side of the front upright. Slide the opening over one hip. Reach around the front and pull the rest of the orthosis around you. Make sure your neck is inside the neck ring that attaches the front upright to the back uprights.</li>
<li>Make sure all the straps and correction pads are outside the plastic girdle.</li>
<li>Make sure the orthosis is facing straight ahead and not twisted. The opening of the orthosis should be in the middle of your back. The opening of the orthosis at the back should be centered on the crease between the buttocks. The waist roll of the orthosis (the indentations inside) should sit at your waist, just above the hip bones.</li>
<li>Initially, it may be easier to tighten the orthosis while lying down. Your spine will be straighter. You will also have more room to tighten the orthosis properly. Once your spine becomes accustomed to the orthosis, you may be able to tighten it while standing up.</li>
<li>Thread the closure strap through the buckle on the lower part of the orthosis at the back and tighten to the marked hole. Do up the closure nut behind your neck at the top of the orthosis. As you do up the orthosis, you should be checking the positioning to ensure that the waist rolls are properly positioned. </li>
<li>Pull the extra cloth of the undershirt down around the bottom and top of the orthosis so that it is smooth.</li>
<li>Make sure there are no wrinkles in the undershirt. Wrinkles can cause sores on your skin.</li>
<li>The straps of the corrective pads should then be threaded under the uprights and done up on the appropriate buckles to the correct tightness (marks). You do not need to undo both front and back corrective pad straps when putting on or taking off the orthosis. Either front or back ends can be left done up and the opposite ends can be undone. </li>
<li>Always do the orthosis up in the marked holes. Never loosen it. If you wear your orthosis loosely, you will have skin problems and discomfort. A loose orthosis will shift around each time you move and irritate your skin and prominent bones (ribs and hip bones). If you experience regular stomach bloating, you may slightly loosen the orthosis (no more than one hole) on each strap for a short time. </li>
</ol>

<h2>Getting used to wearing the orthosis</h2>
<p>Getting comfortable using your orthosis is like getting used to new tight shoes. The following program is designed to help your skin and muscles adjust to having the orthosis on. It is a gradual build-up of time that usually takes two to three weeks. </p>
<p>As you read through this section, refer to the <a href="/Article?contentid=1118&language=English">orthosis daily wear schedule</a>. You will follow five stages of orthosis wear, starting with six hours, then building up to eight, then 14, then 16 and finally 22 to 23 hours per day. This is simply a guide. You may make your own schedule as long as it is gradual and the brace is worn full-time after three weeks.</p>
<p>Pin the orthosis daily wear schedule to a bulletin board and check off each day as you complete it. If you fall behind, do not skip days. Keep following the schedule as closely as possible. </p>
<h3>Stage 1 (Day 1 to Day 5)</h3>
<ul>
<li>Goal: To wear the orthosis for six hours after school. </li>
</ul>
<p>Follow the instructions in day 1 to day 5 for building up to six hours. If you start your orthosis wear during school holidays, follow the same time periods suggested in the schedule. When you have completed day 5, go on to Stage 2. </p>
<h3>Stage 2 (Day 6 to Day 10)</h3>
<ul>
<li>Goal: To wear the orthosis for eight hours to bed. </li>
</ul>
<p>Follow the instructions in day 6 to day 10 for building up to eight hours. Try to wear the orthosis all through the night, the first night if possible. When you reach day 10, go on to Stage 3. </p>
<h3>Stage 3 (Day 11 to Day 15)</h3>
<ul>
<li>Goal: To wear the orthosis for 14 hours, after school and to bed. </li>
</ul>
<p>Follow the instructions in day 11 to day 15 for building up to 14 hours. This stage should be relatively easy once you have mastered sleeping in the orthosis. Leave the orthosis on for the entire time, except for skin care before bed. When you reach day 15, go on to Stage 4. </p>
<h3>Stage 4 (Day 16 to Day 17)</h3>
<ul>
<li>Goal: To wear the orthosis for 16 hours, to school and to bed. </li>
</ul>
<p>On day 16, do not wear the orthosis until you go to bed, then put the orthosis on and do not remove it until lunchtime. Day 17 is the same except the orthosis is left on all day at school. </p>
<h3>Stage 5 (Day 18 to Day 20)</h3>
<ul>
<li>Goal: To wear the orthosis for 22 to 23 hours. </li>
</ul>
<p>By the end of this stage, you will be into full-time orthosis wear. You may take your daily two hours out of the orthosis whenever you wish: for example, to take gym at school, to eat dinner and so on. </p>

<h2>At SickKids</h2>
<p>If you are an Ontario citizen, 75% of your spinal orthosis is paid for by the Assistive Devices Program (ADP). The remaining 25% is the responsibility of the family. Most private insurance companies may cover the cost of the client portion of the spinal orthosis. If you need help to pay for the orthosis, visit our reception desk for a listing of charitable organizations that may assist you. Please visit or contact The Centre for Orthotics for further information on pricing.</p>
<p>All proceeds from orthotic treatment at The Centre for Orthotics go to support patient care and research at SickKids. For more information, please see <a href="http://www.centrefororthotics.ca/">www.centrefororthotics.ca. </a></p>

AboutKidsHealth is proud to partner with the following sponsors as they support our mission to improve the health and wellbeing of children in Canada and around the world by making accessible health care information available via the internet.